Healthcare Provider Details

I. General information

NPI: 1356201073
Provider Name (Legal Business Name): MRS. EMILY TENNESSEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL AVE
TULIA TX
79088-2433
US

IV. Provider business mailing address

PO BOX 846
TULIA TX
79088-0846
US

V. Phone/Fax

Practice location:
  • Phone: 806-995-4122
  • Fax: 806-995-4663
Mailing address:
  • Phone: 806-995-4122
  • Fax: 806-995-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: